5 Joining the Industrialized World U.S. is the only country that utilizes ICD-10 (and -9) codes for reimbursement. It is the only country that has Procedure Coding System (PCS) Significantly greater number of codes to transition. NOTE: Continue to use CPT codes.

12 Reality of ICD-10 It s not a modification/revision of ICD-9 Dewey Decimal System vs. Library of Congress book classification Significant change to the health care system Effect on revenue and operations Administrative burden

13 Impact on Physicians Select the correct (and most specific) ICD-10 diagnosis code No one will need to be an ICD-10 black belt or be able to recite codes any more than we do now! Provide the appropriate, complete, and accurate supporting documentation consistent with the specific ICD-10 code Justification of medical necessity Necessary for coders to select the correct diagnosis and/or procedure code Failure to code and document correctly is likely to result in Clinical Documentation Inquiries (CDIs) Reduced department revenue

14 Observations for adoption general approach It all starts with any changes required in documentation, which are specialty specific. Understanding documentation requirements first will make coding, especially in EPIC, more efficient. Generation of Problem List and Diagnosis/Charge capture ICD-10 team undertaking documentation review for all departments to identify current state wrt ICD-10 suitability.

15 Best Practice Documentation - Example There will be guidance on how we are doing.

16 Areas of uncertainty What level of specificity will be needed in ICD-10 for diagnoses/procedures to be acceptable for reimbursement? Asthma, unspecified; asthma, allergic. How many letters/digits May differ amongst service areas: both coding and documentation. What are third party payers thinking/planning? Closer scrutiny for noncompliance denials Are they ready? In the end lack of preparedness will directly impact individual department s revenue and volume of clinical documentation inquiries.

2FORMATS AND CONVENTIONS OF DIAGNOSIS CODING SYSTEMS Learning Outcomes After completing this chapter, students should be able to 2.1 Explain the layout of the ICD-9-CM and ICD-10-CM manuals. 2.2 Differentiate

ICD-10 Provider Preparation After browsing this slide deck, the viewer will become more familiar with the following information: What are the origins of ICD-10? Why transition to ICD-10? Why ICD-10 matters.

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CHAPTER 5 Medical Terminologies and Classification Systems Objectives After reading this chapter, you should be able to: Classify various medical nomenclatures Differentiate common classification systems

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This reference document was developed to answer provider questions about the mandated transition to the ICD-10 code sets. It will be updated as additional information becomes available. We encourage you

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